Insurance Update:
Aetna Institutes Published New Facility Program Requirements

Published in October 2014 Issue             

p>From ASMBS Insurance Committee -- Matthew Brengman, MD, Committee Chair

Matthew Brengman, MD

The most recent “Aetna Institutes of Quality Bariatric Surgery facility program requirements” have been published on the Aetna website. Click here to view the full document.

Highlights of the policy include:

  1. Incorporation of a measure of “cost efficiency”

  2. Fourteen (14) mandatory requirements include:

  1. Twelve (12) months of continuous bariatric surgery

  2. The facility must be “in-network” with Aetna

  3. One surgeon who has performed at least 100 bariatric procedures over the previous 24 months

  4. Specific targets for mortality, re-operation, re-admission, and major complications

  5. One year follow-up rate of at least 75%

  6. Presence of a Quality Improvement Program

  7. All surgeons must be board certified

  1. At the initial publication, the Institute of Quality criteria required that bariatric programs be certified by BOTH the MBSAQIP and the SRC. ASMBS leadership discussed this requirement with the Aetna Medical Director, Dr. Jerry Scallion, during the recent Obesity Summit. Dr. Scallion confirmed the unintended redundancy. The requirement has been modified to require EITHER MBSAQIP or SRC certification.

ASMBS leadership continues to have a positive dialog with the Aetna program and Dr. Scallion to achieve as much coordination with the MBSAQIP as possible.